Mindfulness and Chronic Pelvic Pain

By now many people have heard the term “mindfulness”.

Some people associate it with meditation, while others relate to it was being “fully present”.  According to the American Psychological Association (APA.org, 2012), mindfulness is: “A moment-to-moment awareness of one’s experience without judgment. In this sense, mindfulness is a state and not a trait. While it might be promoted by certain practices or activities, such as meditation, it is not equivalent to or synonymous with them.”  From this we can see that  mindfulness is a state that can be brought on through practice. It’s not a static state, are people are not ‘born more mindful’ than others. It involves awareness, and what we gain from this awareness. 

Another definition comes from Jon Kabat Zinn, who has engaged in significant work on mindfulness-based stress reduction (MBSR): “The awareness that arises from paying attention, on purpose, in the present moment and non-judgmentally” (Kabat-Zinn, in Purser, 2015). This is the more widely accepted definition in practitioner and academic literature, and perhaps more descriptive for those who want to start practicing. As well as awareness, Kabat-Zinn tells us to focus conscious attention on the ‘right here, right now’. It’s a concept that most who practice meditation will already be familiar with, and it’s why the two often go hand in hand.

Often in pelvic physical therapy we discuss the mind-body connection. This is vital to success in the management of pelvic pain. The pelvic floor muscles are innervated by the pudendal nerve which is made up of both motor and autonomic nerve fibers. In contract to this, most other skeletal muscles are innervated by nerves that only contain motor fibers, not autonomic. Because of this unique physiology, the pelvic floor muscles will respond to training in mindfulness, and this should be incorporated into the treatment of pelvic pain. 

Mindfulness is a practice of focus on being intensely aware of what you’re sensing and feeling in the moment, without interpretation or judgment. 

There are two components of mindfulness:

  1. Involves the self-regulation of attention so that it is maintained on immediate experience, allowing for increased recognition of mental events in the present moment. 
  2. Involves adopting a particular orientation toward one’s experiences in the present moment, characterized by curiosity, openness, and acceptance.

It is a form of mental training used to reduce cognitive vulnerability to reactive modes of mind that might otherwise heighten stress and emotional distress, of while meditation is a technique used to enable mindfulness. Training in meditation can be used to cultivate the capacity to evoke and apply mindfulness to enhance emotional well-being and mental health.

There are many variations and forms of meditation. The basics of many are:

  • Get into a comfortable position
  • Maintain attention on a particular focus. A common theme in many is to focus on your own breathing.
  • When your attention wanders from the breath to other thoughts and feelings that arise, you simply take note of them and then let them go, then turn your attention back to your breathing. 
  • Do not try to suppress your thoughts or feelings. Many forms of meditation teach that they are welcome, however do not dwell on them. Allow them to come, but then allow them to go as you focus on your breathing. 
  • Repeat this process each time that your attention wanders away from your breath. 

It’s important to note that there is an emphasis on simply taking notice of whatever your mind happens to wander to and accepting each object (any stimulus: thoughts, feelings, sounds, etc.) without making judgements or elaborating on its implications, additional meanings, or need for action. This same approach is trained to be used outside of “meditation time” to bring this type of awareness to the here-and-now throughout the course of the day. Participants are trained to use their breath as the anchor, and when attention moves to thoughts, worries, stress, etc. to return to this state of mindfulness by going through the procedures of medication.

So, what does the research say? There seems to be some good evidence in favor of it to manage chronic pain (which includes pelvic pain): In 2010 a meta-analysis of eight randomized controlled outcome studies were performed to investigate the effects of mindfulness-based stress reduction on adults with chronic medical conditions, including chronic pain. They concluded that the evidence supports the efficacy of it for reducing distress and disability in this population.1  In addition to this, several correlational studies found that higher levels of mindfulness are associated with lower pain intensity ratings in chronic pain populations.2 3  In 2013 Reiner et al. completed a literature review to examine whether mindful-based interventions (MBIs) reduced pain intensity. They reviewed 16 studies, eight controlled and eight uncontrolled. When comparing the effect of mindful-based interventions on pain intensity to control groups, six of the eight studies report significantly greater reductions in pain intensity for the MBI groups compared with controls.4 Another study by Grossman et al. looked at 58 female patients with fibromyalgia, comparing MBI to a control group which utilized social support, relaxation, and stretching exercises. Results from this study indicated significantly greater pain reduction for the MBI group compared with the control intervention.5  Finally, another study compared the effects of mindfulness-based and cognitive-behavioral stress reduction. They found substantial decreases in pain intensity ratings for the MBSR group and a moderate advantage in posttreatment mean effect size for MBSR vs CBT control group.6

We are starting to see that mindfulness can actually cause positive changes in the brain. Over a period of time and consistent practice the brain begins to change in multiple areas. For instance, in one study, subjects who completed an 8-week mindfulness program demonstrated greater activity of the part of the brain regulating the thalamus as well as the emotional interpretation and regulation centers of the brain. The thalamus showed decreased activity, resulting in decreased nociceptive (pain) sensation.7

Pain is a multidimensional experience that involves sensory, cognitive, and affective factors. A team-approach treatment plan is vital for patients who are suffering from chronic pelvic pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings and should be considered for each patient who is suffering with this condition.

References

  1. Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: A meta-analysis. J Psychosom Res 2010;68(6):539–44.
  2. Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med 2008;31(1):23–33.
  3. McCracken LM, Gauntlett-Gilbert J, Vowles KE. The role of mindfulness in a contextual cognitive behavioral analysis of chronic pain-related suffering and disability. Pain 2007;131(1–2):63–9.
  4. Reiner K1, Tibi LLipsitz JD.Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Med. 2013 Feb;14(2):230-42. doi: 10.1111/pme.12006. Epub 2012 Dec 13.
  5. Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U. Mindfulness training as an intervention for fibromyalgia: Evidence of postintervention and 3-year follow-up benefits in well-being. Psychother Psychosom 2007;76(4):226–33.
  6.  Smith BW, Shelley BM, Dalen J, et al. A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction. J Altern Complement Med 2008;14(3):251–8.
  7. Zeidan F, Vago DR. Mindfulness meditation-based pain relief: a mechanistic account. Ann N Y Acad Sci. 2016;1373(1):114-127. doi:10.1111/nyas.13153

 

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